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Important Announcement: The DIR Restructured – Existing Users Should Confirm DIR Account Status and Data Access

The NRDR restructured all existing DIR accounts effective August 18, 2018.  This changed the way sites are structured, reassigned some users, added a new user type, and limited the data to which some of the users have access.  It also eliminated a few reports.

If you are a DIR user at any level it is important you log in and check your account status to make sure it works for you and that you can access the reports and perform the tasks you were able to do prior to the change. 

Here is a summary of the changes taken in large part, and sometimes copied directly, from the NRDR Announcement.   As always, Dose Registry Support Services is ready to help facilities navigate the DIR/NRDR.   Michael Bohl

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Master Accounts have been replaced by Corporate Accounts.  Corporate accounts will not accept data whereas previously they would.  Corporate Accounts are managed by a single Corporate Account Administrator who is responsible for all communications with the NRDR team.

Critical to Understand:  Corporate Account Administrators have no default access to data management for their facilities, e.g. submitting data via web forms, data upload files or web services, viewing data through the portal, searching cases/exams for all subordinated facilities, accessing patient data, etc.

In order to have access to facility data, Corporate Account Administrators must also have a specific user profile associated with the facility ID such as Facility Administrator, Registry Administrator or Facility User.  If you used your Master Account administrator log in credentials to submit data or review reports you may not be able to do so under those credentials today – you would have to create a second account type to do so.  You won’t know until you log in and test the system.

For existing “Master” facilities, the master facility ID will become the corporate account ID, and the master Facility Administrator will become the Corporate Account administrator.

For standalone facilities, the existing Facility Administrator will become the Corporate Account Administrator, and a new Corporate Account ID will be created and sent to them.

The Facility Administrator, Registry Administrator, and Facility User roles remain unchanged. You can find more information in link to NRDR Accounts and Profiles link accessible through the Announcement document link above.

There is a new user type named Service User.  The new Service User profile allows support staff, such as IT personnel, to have NRDR credentials without access to data or reports. Service User profiles are corporate-level roles and are associated with all facilities within a corporate account, so there is no need to update a Service User’s profile when facilities are added to a corporate account.

The NRDR announcement also discusses the new TRIAD Site Server v.4.5.  You may want to plan to upgrade as it contains several convenient features like mapping a new scanner directly from the unmapped Data tab and the ability to view the number of scans submitted by scanner.

There are other changes as well.  Please click on the Announcement link at the beginning of this post to read more.

 

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Tailored DIR Analysis; Is your current solution providing less for more?

The Dose Index Registry (DIR) is a powerful, flexible tool from which facilities can learn a great deal.  The most common use is to use the DIR’s dose comparison reports identify dose reduction opportunities:  Never before have facilities been able to identify dose reduction opportunities so easily.

But, there is so much more to glean from the DIR if facilities work with someone who understands how to take advantage of the DIR’s data.  In our opinion, too many facilities spend thousands of dollars each year unnecessarily to purchase expensive third-party solutions when the information is readily available from the DIR for free or at a very low cost.  This article will describe one example of the unique, low-cost analyses Dose Registries Support Services offers its clients as they work to lower doses, increase patient safety, and improve their CT services:  Protocol Use (or in this case) Misuse.

Protocol Misuse:  While reviewing one facility’s DIR data we noted they used two different protocols for RPID22- CT Head wo Contrast; their names were CT Head_wo contrast and CT Head_wo_kyphotic.  The CT Head wo contrast protocol uses the standard field of view while the kyphotic protocol uses a larger field of view (up to 500mm).

In our experience it is common for facilities to use a larger field of view to accommodate kyphotic patients whose kyphosis does not allow them to be positioned at isocenter.  These are typically elderly people whose kyphosis is due to osteoporosis-related compression fractures.  In these cases, technologists often use a larger field of view to image the head which is located some distance above isocenter thereby requiring a larger field of view to image.  Most technologists then reprocess the images to a normal field of view prior to sending the images for interpretation.  While appropriate when warranted, a larger field of view can significantly decrease mage resolution and should be selected only when necessary.  In our experience, the need to use this technique occurs in the low single digit percentage of the time in most community-based facilities.

Protocol Use ExampleWhat concerned us after performing this analysis was that the Kyphotic protocol was used an astounding 49.5% of the time at this single facility!  See Table 1.   We summarized our findings in our report to the department manager.  Upon investigation it was found that one technologist used the kyphotic protocol exclusively whether the patient was kyphotic or not, reprocessing the images to the smaller FOV prior to sending the images for interpretation.  This practice was quickly stopped.

One of my next articles will discuss what Charts 1 & 2 below signify.  Anyone care to guess about what these charts suggest may be happening?   Hint, if you are not doing your quality checks, you should.

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Dose Registry Support Services provides personalized, tailored dose support services to facilities and radiologists.  This story represents but one creative, proprietary analysis Dose Registry Support Services brings to its clients – an approach not generally provided by other solutions.  Is your solution providing these kinds of insights to you?  To learn more about Dose Registry Support Services’ cost effective solutions and how we can help your department improve its CT services contact us or visit www.doseregistry.com.

Gap Analysis

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Providing Low-cost, Tailored & Unique Services to Community Hospitals and Radiology Groups

The Dose Index Registry (DIR) is a powerful, flexible tool from which facilities can learn a great deal.  The most common use is to use the DIR’s dose comparison reports identify dose reduction opportunities:  Never before have facilities been able to identify dose reduction opportunities so easily.

But, there is so much more to glean from the DIR if facilities work with someone who understands how to take advantage of the DIR’s data.  In our opinion, too many facilities spend thousands of dollars each year unnecessarily to purchase expensive third-party solutions when the information is readily available from the DIR for free or at a very low cost.  This article will describe one example of the unique, low-cost analyses Dose Registries Support Services offers its clients as they work to lower doses, increase patient safety, and improve their CT services:  Protocol Use (or in this case) Misuse.

Protocol Misuse:  While reviewing one facility’s DIR data we noted they used two different protocols for RPID22- CT Head wo Contrast; their names were HEAD_WO and Head Kyphotic_ExtendedFOV.  The Head_WO protocol uses the standard field of view while the kyphotic protocol uses a larger field of view (up to 500mm).

In our experience it is common for facilities to use a larger field of view to accommodate kyphotic patients whose kyphosis does not allow them to be positioned at isocenter.  These are typically elderly people whose kyphosis is due to osteoporosis-related compression fractures.  In these cases, technologists often use a larger field of view to image the head which is located some distance above isocenter thereby requiring a larger field of view to image.  Most technologists then reprocess the images to a normal field of view prior to sending the images for interpretation.  While patient friendly and appropriate when warranted, a larger field of view can significantly decrease mage resolution, and should be employed only when necessary.  In our experience, the need to use this technique occurs in the low single digit percentage of the time in most community-based facilities.

Protocol Use ExampleWhat concerned us after performing this analysis was that the Kyphotic protocol was used an astounding 51% of the time at this single facility!  See Table 1.   We summarized our findings in our report to the department manager.  Upon investigation it was found that one technologist used the kyphotic protocol exclusively whether the patient was kyphotic or not, reprocessing the images to the smaller FOV prior to sending the images for interpretation.  This practice was quickly stopped.

One of my next articles will discuss what Charts 1 & 2 below signify.  Anyone care to guess about what they represent and what their trend lines suggest?   Hint, if you are not doing your quality checks, you should.

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Dose Registry Support Services provides personalized, tailored dose support services to facilities and radiologists.  This story represents but one creative, propriety analysis Dose Registry Support Services brings to its clients – an approach not generally provided by other solutions.  To learn more about Dose Registry Support Services’ cost effective solutions and how we can help your department improve its CT services contact us or visit www.doseregistry.com.

Gap Analysis